Experience in similar position with Medical Aid Scheme or Medical Aid Scheme Administrator – Non-Negotiable
Large Managed Care Corporate (Medical Scheme Sector), seeks an Operations Manager who will be responsible to ensure effective implementation of all scheme, provider and vendor related rules by the Data Admin Department, ensuring tasks are completed according to agreements
Requirements, but not limited to:
- Degree required: BPharm, BCom or BSc
- 4 – 5 years related experience in medical schemes
- Ensure great communication skills are maintained with internal and external stakeholders
- Expertise on current core processing system
- Clinical expertise would be advantageous
- Expertise with technology
- Process Management experience
- Workforce Management & Development
- Ensure Quality Assurance responsibilities are completed as per SLAs & SOPs with emphasis on Quality output
- Manage the Quality Control responsibilities with emphasis on Claim file transfers, QC of NAPPI codes, ERA’s, Providers Statements, etc.
- Managing end to end Funder/ scheme reconciliation process in the Fund Control Department
- Responsible for evaluation & implementation of procedures and processes within and ensuring continuous improvement and automation
- Responsible to ensure data / rules are loaded timeously & not compromise Implementation go-live
- Manage timelines successfully by proactively negotiating departmental deliverables
- CIM Database to be maintained according to SOP MPD026
- Review, update and maintain SOP’s
- Ensure all Funder reconciliation related tasks are effectively dealt with to not compromise provider payments
- Ensuring all Implementation Documentation is systematically filed & up to date for ease of reference
- Electronic and manual filing system – ensure that this is managed correctly
- Ensure effective historical record keeping is in place & maintained for audit purposes
- Manage the timelines and quality of each DA, Implementation & QC task pertaining to relevant projects
- Assist workforce with prioritising and crisis management, provide mentorship & development where and as needed, identify training requirements
- Investigate incidents & identify root causes, action improvements with focus on prevention
- Analyse logged queries on Implementation Ops Queue in RT & action suitably ensuring SLA’s are adhered
- Supervise RT dashboards ensuring requests are actioned according to SLAs requirements
- Conduct DR testing as per defined Test plan
Please apply to response “at” [URL Removed]
Call: 0860 100 MVG (684) to enquire
Submit CV application with supporting documents:
- Copy of Matric Certificate
- Copy of Qualification(s)
- Comprehensive CV with related experience gained to be showcased
Desired Skills:
- 4 – 5 years related experience in medical schemes
Desired Work Experience:
- 2 to 5 years
Desired Qualification Level & Accreditations:
- Degree
- South African Pharmacy Council